Zenker's diverticulum
| Zenker's diverticulum | |
 | |
|---|---|
| ICD-10 | K22.5 |
| ICD-9 | 530.6 |
| DiseasesDB | 31174 |
| MeSH | D016672 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Hypopharyngeal diverticulum
Overview
In anatomy, Zenker's diverticulum is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the oesophagus).
Historical Perspective
It was named in 1877 by German pathologist Friedrich Albert von Zenker.
Pathophysiology
When there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter. While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, or more accurately Killian-Laimer triangular dehiscence). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus.[1]
Epidemiology and Demographics
Zenker diverticulum mainly affects older adults.
Diagnosis
Symptoms
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as the following:
- Dysphagia: difficulty swallowing
- Globus: a sense of a lump in the neck
- Regurgitation: reappearance of ingested food in the mouth due to the pouch filling up
- Cough: as some food may be regurgitated into the airways
- Halitosis: smelly breath, as stagnant food is digested by microrganisms)
- Odynophagia or pain with swallowing is generally not present
Barium Swallow
A simple barium swallow will normally reveal the diverticulum.
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Barium swallow graphy: Zenker's diverticulum -
Barium swallow graphy: Zenker's diverticulum -
Barium swallow graphy: Zenker's diverticulum
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Barium swallow graphy: Zenker's diverticulum -
Barium swallow graphy: Zenker's diverticulum
Histopathological Findings: Esophagus; Zenker's diverticulum
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Treatment
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling[2][3] (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope[4]. Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests it less effective than stapling.[5]
References
- ↑ PMID 12903677 Pathogenesis and methods of treatment of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2003 Jul;112(7):583-93
- ↑ PMID 15453934 Endoscopic stapling of pharyngeal pouch, J Laryngol Otol. 2004 Aug;118(8):601-6
- ↑ PMID 12782805 Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases, Laryngoscope. 2003 Jun;113(6):957-65
- ↑ PMID 15966520 Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2005 May;114(5):347-51
- ↑ PMID 16954989 The Endoscopic Management of Zenker Diverticulum: CO2 Laser versus Endoscopic Stapling, Laryngoscope. 2006 Sep;116(9):1608-11
Template:Gastroenterology de:Zenker-Divertikel it:Diverticolo di Zenker